10.30am David Lawson – Question about medication

A 34 year old man – David makes a telephone appointment with you as there were no other appointments for the GP’s. He speaks very quietly and asks you for a prescription for Viagra. He says he has been buying it for 4 years and can no longer afford it.

When you ask him if he has been for investigations for impotence, he says no. He feels it is due to stress.

He has no urinary symptoms, no haematuria, no past trauma. 

What history would you take? 

  • Take a full medical history to ask if there were issues prior to starting the Viagra 
  • Check prior to commencing the Viagra if the patient was able to get an erection, or if so, was it sufficient to penetrate and also was it erect for long enough
  • Had the patient been in a car accident – to cause any pelvic trauma 
  • Check social history such as – different partners, sexuality, was there any stress such as family issues or job 
  • Check also for any signs of potential domestic violence  
  • Weight gain over the years 
  • Depression and anxiety 
  • Lifestyle – such as smoking, alcohol or using illicit drugs 
  • Check if patient is a cyclist 
  • Check if wakes up with erection – if so, more likely to be psychological 

Suggestions of investigations you may want to carry out before giving him a prescription over the phone? 

  • Full Blood count (FBC) 
  • Thyroid Function Test (TFT) – Thyroid issues 
  • HbA1c – Diabetes 
  • PSA and– Prostate cancer 
  • testosterone deficiency & SHBG– Hypogonadism 
  • Cardiovascular screening – Lipids, Liver Function Tests (LFT’s) 
  • Blood pressure check 

What are the possible causes for impotence? 

  • Diabetes 
  • Prostate Cancer 
  • Thyroid issues such as hypothyroidism 
  • Neurological 

This is not an urgent consultation, there are no red flags. You book him in to see you after investigations.